Adhesive Capsulitis Overview

Adhesive Capsulitis (Frozen Shoulder)

• A well-defined disorder causing progressive pain and stiffness in the shoulder
• Symptoms usually resolve spontaneously after about 18 months
• Cause is unknown
• Associated with conditions like diabetes, Dupuytren's disease, hyperlipidemia, hyperthyroidism, cardiac disease, and hemiplegia
• Can sometimes occur after recovery from neurosurgery

Clinical Features

• Patients are typically aged 40-60
• Often preceded by a history of (sometimes minor) trauma
• Pain gradually increases in severity, preventing sleeping on the affected side
• Pain subsides after several months, but stiffness typically persists for another 6-12 months
• Movement may return but not always to full normal range, and some pain may persist
• Active and passive movement is limited in all directions

Diagnosis

• Characterized by painful restriction in movement despite normal X-rays
• Follows a natural progression through three phases

Treatment

• Analgesics and anti-inflammatory drugs
• Physical therapy and rehabilitation
• Manipulation under general anesthesia

Physical Therapy

• Painful Stage: Use pain modulation techniques (e.g., TENS), and avoid aggressive stretching exercises. Patients position themselves to minimize the affected limb use. Instead of passive postures, ask patients to involved the unaffected arm to support the affected arm. Codman and posture exercises may be used.
• Freezing Stage: Focus on maintaining the current range of motion. Gentle extension, within the available range, is necessary but avoiding reaching the limit of motion. The use of pillows or thoracic positioning may be recommended to promote sleep. No aggressive stretching or resistance exercises should be performed. Encourage patients to "climb the wall" in the scapular plane
• Frozen Stage: Patients demonstrate motion limitation, but pain is minimal. Exercise and range of motion work within end-range are encouraged, as well as strengthening exercise. Manipulations can be used at this stage.
• Thawing Stage: Return of motion is a hallmark, but capsular volume is often not restored. Variety of stretching maneuvers may be effective. Treatments for this stage include mobilizing the scapula-move the scapula over the fingers, mobilize the clavicle, and soft tissue techniques like those on rotators, pectoral muscle, etc.

Differential Diagnosis

• In patients with diabetes, signs of inflammation may be absent during the initial stages
• Severe shoulder injury may cause stiffness, but usually pain gradually lessens
• The pattern of pain and stiffness following a forearm fracture differs from a typical frozen shoulder

Important Considerations

• Patients with diabetes may have a less favorable response to manipulation, even in the frozen stage
• Aggressive stretching is not recommended during the early stages

This quiz covers adhesive capsulitis, commonly known as frozen shoulder. It includes information about clinical features, diagnosis, and associated conditions. Ideal for medical students and healthcare professionals looking to deepen their understanding of this disorder.